Pioneering evaluation in Brazil of microscope-integrated optical coherence tomography with a three-dimensional digital visualization system during pars plana vitrectomy for the treatment of macular hole.

Background: This study aimed to characterize the clinical results and usability of intraoperative optical coherence tomography (iOCT) associated with a digital visualization system in vitreoretinal surgery for macular hole correction.

Methods: This is a descriptive observational study of patients undergoing vitreoretinal surgery for macular hole at Brazilian Eye Surgery Center in which the digital visualization system associated with iOCT was used. Anatomical and functional results were collected 6 months after surgery. Macular hole closure rates, pre- and post-operative visual acuity were measured in addition to surgeon feedback and the percentage in which the technology allowed intraoperative decision-making.

Results: 25 eyes of 25 patients were included in the study. The mean preoperative visual acuity was 20/100, ranging from 20/50 to less than 20/400, and postoperative visual acuity was 20/60, ranging from 20/25 to less than 20/400. The time spent with iOCT did not result in surgical delay, as the average time spent was 3.24 extra minutes spent per surgery. Closure of the macular hole was achieved successfully in 92% of cases. In 8% of them surgical success in closing the macular hole was achieved after a new fluid-gas exchange in the office. The surgeon preferred real-time iOCT and, in 4% (1/25) of cases, it influenced the change in surgical technique, preventing unnecessary ILM (Internal Limiting Membrane) peeling after complete removal of the posterior hyaloid and closing the macular hole. In all cases the surgeon reported valid feedback regarding the use of information provided by real-time OCT. This tool was valid for confirming complete ILM peeling in all cases in which it was performed. Finally, iOCT made it possible to identify the appropriate location to begin creating the ILM flap in 2 cases (8%) both of fragile retina; It prevented a new injection of dyes to identify residual ILM in 8% of cases (2/25) and allowed verification of the correct positioning of the pedicled ILM flap over the hole in 16% (4/25) of cases. Therefore, in 36% of cases (9/25) iOCT was essential for the final surgical outcome.

Conclusion: This study suggests that the use of iOCT integrated with a digital viewing microscope for the treatment of macular holes offers high standard usability and effectiveness for visualizing structures, and impact favorably on decision-making process during pars-plana vitrectomy. These findings suggest that in the near future, expanded use of iOCT could significantly improve tissue management at the vitreomacular interface and improve anatomical and functional results.